No effect of fitness on brachial or forearm vascular function during acute inflammation in young adults.

Acute inflammation is associated with increased risk of cardiovascular events and impaired vasodilatory capacity. Vasodilatory capacity can be measured in different segments of the arterial tree; however, it is unknown if the effects of acute inflammation are vascular segment-specific or if inflammation-induced dysfunction can be attenuated by factors that modulate cardiovascular risk, such as high cardiorespiratory fitness. The purpose of this study was to determine the effect of acute inflammation and fitness on conduit artery, resistance artery, and microvascular function in healthy, young adults. Vascular function was assessed at baseline and 24 h after a typhoid vaccination in 11 low-fit (5 male, 24 yr of age, 34.5 ± 2.9 ml·kg-1·min-1 peak O2 uptake (V̇o2peak)] and 12 high-fit (7 male, 27 yr of age, 56.4 ± 9.7 ml·kg-1·min-1 V̇o2peak) young adults. Vascular assessments included flow-mediated dilation (FMD) of the brachial artery, forearm reactive hyperemia (RH) via venous occlusion plethysmography, and near-infrared spectroscopy (NIRS) during a 5-min arterial occlusion. Acute inflammation was evident with increases in IL-6 and C-reactive protein (P < 0.01), and mean arterial pressure did not change (P = 0.33). FMD was lower in the high-fit group, yet it was reduced in both groups at 24 h, even after controlling for shear (P < 0.05). No effect of acute inflammation was observed for RH or NIRS (P > 0.05). Acute inflammation had nonuniform effects on vascular function throughout the arterial tree in young adults, and fitness did not alter the vascular response. This suggests that cardiorespiratory fitness may not protect the vasculature during acute inflammation in young adults in the absence of age- or disease-related decline in vascular function.

Prevalence, Correlates, and Outcomes of Co-Occurring Depression and Hypertensive Disorders of Pregnancy.

Background: Depression and hypertensive disorders of pregnancy (HDP) are common morbidities during pregnancy. However, our knowledge about the national prevalence, correlates, and outcomes of co-occurring depression and HDP remains unknown. Materials and Methods: Using a multiyear (2002-2014) nationwide inpatient sample, we conducted a population-based, cross-sectional study. Cases, behavioral and clinical covariates, and outcomes were identified using International Classification of Disease, 9th Revision, Clinical Modification Codes. Rates of depression and HDP were calculated across demographics, hospital characteristics, and morbidities. We estimated adjusted odds ratios that represent the unique and joint association of depression and HDP with birth outcomes. Joinpoint regression was used to describe temporal trends in depression and HDP. Results: Among the over 58-million hospitalizations, there were 2,346,619 (3.99%), 1,117,857 (1.90%), and 63,081 (0.11%) cases of HDP, depression, and co-occurring depression and HDP, respectively. Compared to pregnant women without depression and HDP, women with depression and HDP were 3.41 times (confidence interval [95% CI]: 3.15-3.68), 1.94 times (95% CI: 1.65-2.27), and 4.10 times (95% CI: 3.89-4.32) more likely to experience intrauterine growth restriction, stillbirth, and preterm labor, respectively, even after adjusting for potential demographic, socioeconomic, and clinical confounders. Depression- and HDP-related hospitalizations resulted in an additional cost of over $5 billion during the study period. Conclusion: Depression and HDP are associated with increased risk of adverse birth outcomes and significant health care cost, with HDP being the main driving factor. Screening for both HDP and depression followed by multidisciplinary care could alleviate the health and economic burden of HDP and depression.

African-American Women's Perceived Risk for Cardiovascular Disease versus Framingham Risk.

Cardiovascular disease (CVD) is the leading cause of death among African-American women in the United States. Accurate CVD risk perception may motivate these women to participate in health-promoting behaviors; however, perceived risk may not align with objective CVD risk. Our objective was to examine CVD risk perception, risk factors, and objective estimated risk (based on Framingham scores). This was a secondary data analysis of data collected from a 12-month lifestyle PA intervention conducted with 281 African-American women. Subjective perceived CVD risk was measured with two questions; CVD risks were examined via health assessment and self-questionnaire; and objective estimated CVD risk was calculated using the Framingham Risk score. Despite having several objective risk factors for CVD development, most participants perceived their CVD risk as low, and their Framingham scores were low. The Framingham Risk score may not be the best predictor of CVD risk for African-American women.

What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women.

The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index. Logistic regression models were used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), and comorbid conditions. Analyses were stratified by age, and interaction of symptom by age was tested. Four hundred women were enrolled. Mean age was 61.3 years (range 21-98). Older women (n = 163) were more likely to have hypertension, hypercholesterolemia, never smoked, lower BMI, more comorbid conditions, and lower functional status. Younger women (n = 237) were more likely to be members of minority groups, be college-educated, and have a non-ACS discharge diagnosis. Younger women had higher odds of experiencing chest discomfort, chest pain, chest pressure, shortness of breath, nausea, sweating, and palpitations. Lack of chest symptoms and shortness of breath (key symptoms triggering a decision to seek emergency care) may cause older women to delay seeking treatment, placing them at risk for poorer outcomes. Younger African American women may require more comprehensive risk reduction strategies and symptom management.

Subjective Versus Objective Estimated Cardiovascular Disease Risk and Adherence to Physical Activity in African American Women.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death for African American (AA) women in the United States. Despite high prevalence of CVD risk factors, AA women perceive their CVD risk as low. OBJECTIVE: Our objectives were to (1) identify relationships between subjective (self-reported perceived) CVD risk and objective CVD risk estimated by the American College of Cardiology/American Heart Association atherosclerotic CVD (ASCVD) risk estimator, (2) identify demographic and psychosocial factors associated with subjective perceived risk and discrepancy with objective estimated CVD risk, and (3) determine whether subjective perceived CVD risk was associated with physical activity (PA) adherence. METHODS: This was a secondary data analysis of data collected from a 12-month lifestyle PA intervention conducted with 281 AA women. Subjective perceived CVD risk was measured by 1 question; objective estimated CVD risk was calculated using the ASCVD score. Women were categorized by congruence or discrepancy between subjective perceived and objective estimated CVD risk. RESULTS: Subjective perceived CVD risk and objective ASCVD risk scores were both low. Approximately 20% subjectively perceived their risk as lower than objective ASCVD scores. Atherosclerotic CVD risk discrepancy groups differed by depressed mood symptoms. Participants reported many perceived barriers to PA. Perceived CVD risk was not related to PA adherence. CONCLUSIONS: The significance of associated CVD risk factors may be underestimated by AA women, leading to discrepancy between subjective and objective risk estimates. Research is needed to clarify relationships among perceived risk, estimated risk using risk calculators such as ASCVD, and health behavior.